Why should we perform a D2 lymphadenectomy in gastric cancer?

Barreto, Savio George; Sirohi, Bhawna

doi:10.2217/fon-2017-0282

Cited by 7 publications

(7 citation statements)

References 32 publications

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“…Local recurrence occurred subsequently, which aligns with literature data: regional recurrence rates as high as 88% following surgery alone have been reported in patients following D1 lymphadenectomy [24]. Noticeably patient population with D2 lymphadenectomy had lower mortality and improved median OS in stage I and III patients [24][25][26].…”

Section: Discussionsupporting

confidence: 87%

Case Report: Epstein-Barr virus Positive Gastric Carcinoma

Gasenko¹,

Hegmane²,

Plate³

et al. 2019

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In 2014, The Cancer Genome Atlas provided a molecular classification defining Epstein-Barr virus (EBV)-positive gastric cancer as a separate subtype. While its prognostic role is still debatable, emerging potential biomarker role for personalized treatment strategies is already recognized by international guidelines. We report a case with successful combined therapy of a 64-year-old EBV-positive gastric cancer male patient. Patient initially presented with locally advanced gastric cancer, which was treated surgically; three years later patient developed recurrence within the remnant stomach and was treated surgically. Two years after operation patient developed distant metastases and was enrolled in a clinical trials’ (NCT01630083) arm 2: receiving chemotherapy and monoclonal antibody claudiximab. This treatment induced durable disease stabilisation for 34 months. After progression, second line chemotherapy with docetaxel and cisplatin provided additional disease stabilisation and symptom control for 8 months. Patient’s overall survival reached 9.1 years. Presented report shows EBV- ositive gastric cancer case with better overall survival compared to reported average, which contributes to the meaningfulness of its distinction as a separate subtype, evidence that targeted therapy is more effective in selected patient groups, and EBV as an emerging biomarker.

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Section: Discussionsupporting

confidence: 87%

Case Report: Epstein-Barr virus Positive Gastric Carcinoma

Gasenko¹,

Hegmane²,

Plate³

et al. 2019

IGH

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“…Our study demonstrated that more lymph nodes were harvested in the ICG group than in the non-ICG group, but what is more interesting is that our study also found a significant difference in D2 stations between the 2 groups. The dissection of D2 stations is a relatively difficult procedure to perform during laparoscopic gastrectomy, and some previous studies have suggested that the incomplete dissection of D2 stations could be a major reason for local recurrence after surgery [ 28 29 ]. Moreover, surgery under fluorescence mode can assist with finding small lymph nodes easily, which would otherwise be omittedduring the traditional mode, which may also explain the likelihood of greater lymph node retrieval.…”

Section: Discussionmentioning

confidence: 99%

Application of Near-Infrared Fluorescence Imaging with Indocyanine Green in Totally Laparoscopic Distal Gastrectomy

Liu

Xing

et al. 2020

J Gastric Cancer

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Purpose: Recently, totally laparoscopic gastrectomy has been gradually accepted by surgeons worldwide for gastric cancer treatment. Complete dissection of the lymph nodes and the establishment of the surgical margin are the most important considerations for curative gastric cancer surgery. Previous studies have demonstrated that indocyanine green (ICG)traced laparoscopic gastrectomy significantly improves the completeness of lymph node dissection. However, it remains difficult to identify the tumor location intraoperatively for gastric cancers that are staged ≤T3. Here, we investigated the feasibility of ICG fluorescence for lymph node mapping and tumor localization during totally laparoscopic distal gastrectomy. Materials and Methods: Preoperative and perioperative data from consecutive patients with gastric cancer who underwent a totally laparoscopic distal gastrectomy were collected and analyzed. The patients were categorized into the ICG (n=61) or the non-ICG (n=75) group based on whether preoperative endoscopic mucosal ICG injection was performed. Results: The ICG group had a shorter operation time and less intraoperative blood loss. Moreover, significantly more lymph nodes were harvested in the ICG group than the non-ICG group. No pathologically positive margin was found and there was no significant difference in either the proximal or distal surgical margins between the 2 groups. Conclusions: Near-infrared fluorescence imaging with ICG can be successfully used in totally laparoscopic distal gastrectomy, and it contributes to both the completeness of D2 lymph node dissection and confirmation of the gastric transection line. Well-designed prospective randomized studies are needed in the future to fully validate our findings.

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“…Assim sendo, para o fim de redução da recorrência, a extensão da retirada de linfonodos mais indicada é a D2 (BARRETO SG, et al, 2017). Barreto SG, et al (2017), analisaram vários estudos no quesito aumento de sobrevida após uma cirurgia de gastrectomia, seja a nível D1 ou D2 e, de acordo com os dados levantados, para todos os estágios de câncer gástrico, a dissecção de até 40 linfonodos parece ser necessária. No entanto, após análise dos resultados clínicos e de uma conclusão lógica dos fatos, concluiu-se que a melhor alternativa para o tratamento do câncer gástrico seja a linfadenectomia D2.…”

Section: Linfadenectomia D1 Versus D2unclassified

“…Centro Universitário de Caratinga (UNEC), Caratinga -MG. *E-mail: tainarasmiranda@hotmail.com 2 Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Teófilo Otoni -MG 3. Universidade Vale do Rio Doce (UNIVALE), Governador Valadares -MG 4.…”

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Gastrectomia com linfadenectomia a nível de D1 ou D2: uma revisão da literatura

et al. 2021

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Este artigo buscou analisar a produção científica sobre pacientes com câncer gástrico submetidos à gastrectomia com linfadenectomia D2, buscando a relação desta técnica com a redução da morbimortalidade e melhora do prognóstico. A linfadenectomia D2 mostra-se mais positiva em relação à D1. Ademais, foi observado complicações mais frequentes de fístulas pancreáticas no pós operatório, em comparação à D1. A linfadenectomia D2, em consonância com a preservação do pâncreas e baço durante a cirurgia, se mostrou mais eficaz, proporcionando maior tempo de sobrevida aos pacientes que possuem tumores gástricos ressecáveis. Entretanto, variáveis como a experiência do cirurgião devem ser investigadas, a fim de melhorar o prognóstico e reduzir a morbimortalidade desses pacientes após as abordagens cirúrgicas.

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Why should we perform a D2 lymphadenectomy in gastric cancer?

Cited by 7 publications

References 32 publications

Case Report: Epstein-Barr virus Positive Gastric Carcinoma

Case Report: Epstein-Barr virus Positive Gastric Carcinoma

Application of Near-Infrared Fluorescence Imaging with Indocyanine Green in Totally Laparoscopic Distal Gastrectomy

Gastrectomia com linfadenectomia a nível de D1 ou D2: uma revisão da literatura

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